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Objective We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population. Design We compared subjects before and after intervention. Setting This study involved two dialysis units operated by a single center. Patients One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study. Intervention All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later. Main Outcome Measures Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period. Results The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032). Conclusions These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.

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The purpose of this study was to develop and test a Learning Package on nutritional counseling principles in diabetes mellitus with specific application for adolescents with insulin-dependent diabetes. The Learning Package was designed to be used as continuing education material for the clinical dietitian. It consisted of two audio tapes, 2 1/2 hours in length, recorded by the author and an accompanying handbook or resourcebook. The resourcebook materials were designed to give further details, provide resources and materials for future reference, visually reinforce the audio presentation, summarize information given in the presentation, and give a bibliography of the references cited. The presentation was divided into four sections: Guidelines for Education of Individuals with Diabetes Mellitus; Educational Program Planning in a Health Care Agency; The Adolescent with Insulin-Dependent Diabetes; The Educator-Client Interaction. Following initial formative evaluations, the Learning Package was field tested in a seminar for practicing clinical dietitians held in three locations with several subjects completing the test in the home setting. Pre and posttest scores and attitudes of the participants towards the Guidelines and Learning Package were collected and are reported. Suggestions for improvement of the Learning Package and demographic data were also collected and are reported. Only 13.8% of the subjects met the 90% criterion as determined on the posttest. There was improvement from both forms of the pretests to the posttest. Tests of statistical significance were not conducted. Participants indicated acceptance of the Learning Package as a continuing education tool and of the Guidelines as of practical value to them in their practices. Recommendations are made for improvement and revision of the Learning Package and final (summative) evaluation and testing before packaging and distribution by the American Dietetic Association. It is concluded that the Learning Package is acceptable to practitioners and, with the suggested revisions, can meet the continuing education needs of dietitians to improve nutritional education of persons with diabetes, as identified in the literature.

Bakgrund NCP är en systematisk, problemlösande metod med ett unikt standardiserat språk som används av yrkesverksamma dietister för dokumentation. Det bidrar till att dietisten agerar utifrån ett kritiskt tänkande där besluten för att hantera patientens nutritionsproblem sker utifrån kunskap av evidensbaserad erfarenhet. Dietisternas Riksförbund (DRF) uppmanar legitimerade dietister att arbeta enligt NCP. Syfte Studiens syfte var att studera svenska dietisters arbete med att ställa nutritionsdiagnoser enligt NCP. Metod En webbaserad enkät utformades. Yrkesverksamma dietister rekryterades via det sociala mediet Facebook samt via DRF:s hemsida. Insamlad data bearbetades i SPSS Statistics 22, och analyserades med Chi-2-test och Correlate Bivariate Spearman. Signifikansnivån bestämdes till p-värde &lt; 0.05. Resultat 119 dietister deltog i studien varav 103 (87 %) skrev nutritionsdiagnoser. I genomsnitt hade dietisterna arbetat i 2 år (1-3 år) med NCP, och över hälften arbetade inom akutsjukvård. Analysen visade att det fanns ett samband mellan antal år dietisterna arbetat med NCP och hur många nutritionsdiagnoser de skrev (r=-0.197, p=0.046). Ett samband visades även mellan tiden dietisterna arbetat med NCP och tiden det tog att skriva nutritionsdiagnoser (r=-0.226, p=0.022). Av de 103 dietisterna som använde NCP ansåg 60 % att deras kunskap och erfarenhet kunde förbättras, 89 % tyckte att nutritionsdiagnoser var användbara. Engelskan i referensbladen tyckte 48 % till viss del var svårtolkad och (n=13) angav att översättning till svenska kunde underlätta arbetet. Det framgick att mer än hälften (53 %) av dietisterna ibland utformade PES-meningar utan att ha funnit passande tecken/symtom i referensbladet. Slutsats Svenska dietister önskar mer kunskap och utbildning i NCP och översättning av referensbladen till svenska skulle sannolikt kunna öka användandet av nutritionsdiagnoser. En vidare implementering av NCP i Sverige behövs. / Background The Nutrition care process is a systematic, problem-solving approach with a standardized language used by dietitians for documentation. It stimulates dietitians to critically appraise and take evidence-based decisions on a patient's nutritional problems. The Swedish Association of Clinical Dietitians (DRF) appeals qualified dietitians to work according the NCP. Objective The aim was to study Swedish dietitians’ work with nutrition diagnosis according to the NCP. Method(s) A web-based questionnaire was developed. Dietitians was recruited through the social media Facebook and the DRF website. The collected data were processed in SPSS, analyzed by Chi-2-test and Correlate Bivariate Spearman, with significance level at p &lt; 0.05. Results A total of 119 dietitians responded to the questionnaire and 103 (87 %) of the respondents wrote nutrition diagnosis. The respondents had on average worked with the NCP for 2 years (range 1-3 years), and over half worked in hospitals. There was a correlation between years working according to the NCP and the number of written diagnosis (r=-0.197, p=0.046). Also, the time for writing a nutritional diagnosis was reduced as the experience of working with NCP increased (r=-0.226, p=0.022). It was 60 % that thought their knowledge and experience in NCP could be improved, 89 % stated that the NCP was useful. The English in the reference sheets 48 % of the respondents said partly was difficult to understand and (n=13) wanted them to be translated into Swedish. It showed that more than half (53 %) of the dietitians sometimes composed PES-statements without finding the appropriate signs/symptoms in the reference sheet. Conclusion Swedish dietitians consider themselves to be in need of more knowledge and training in the NCP, and translations of the reference sheets would possibly increase the use of nutrition diagnosis. A further implementation of the NCP is needed in Sweden.